Karaca C, Yilmaz C, Ferecov R, Iakobadze Z, Kilic K, Caglayan L, Aydogdu S, Kilic M
Department of General Surgery, Izmir University of Economics, Faculty of Medicine, Izmir, Turkey.
Department of Liver Transplantation, Izmir Kent Hospital, Izmir, Turkey.
Transplant Proc. 2017 Oct;49(8):1841-1847. doi: 10.1016/j.transproceed.2017.04.028.
Venous reconstruction in living-donor liver transplantation for Budd-Chiari syndrome (BCS) has challenges because the grafts from living donors lack vena cava, and hepatic venous anastomosis must be performed on an already-thrombosed and/or stenosed inferior vena cava. Several techniques are described to overcome this problem, and we represent our experience with 22 patients.
Medical recordings of 22 patients were retrospectively collected, and disease-specific data as well as recordings about surgical technique were analyzed.
Creation of a wide, triangular de novo orifice was the main method used for venous drainage, which was used in 19 patients. The remaining 3 patients had totally thrombosed vena cava; thus, direct anastomosis to the supra-hepatic portion of the vena cava was used in 2 patients and an anastomosis to the right atrium was used in 1 patient.
Venous reconstruction in BCS can be achieved without the use of patch-plasty, and the inferior vena cava can be safely resected in selected patients. Living-donor liver transplantation is a feasible option for the treatment of BCS, considering the scarcity of cavaderic donors.
布加综合征（BCS）活体肝移植中的静脉重建存在挑战，因为活体供肝缺乏腔静脉，且肝静脉吻合必须在已形成血栓和/或狭窄的下腔静脉上进行。已有多种技术用于克服这一问题，我们介绍22例患者的经验。
回顾性收集22例患者的病历记录，分析疾病特异性数据以及手术技术记录。
创建一个宽大的三角形新开口是主要的静脉引流方法，19例患者采用了该方法。其余3例患者的腔静脉完全血栓形成；因此，2例患者采用直接与腔静脉肝上段吻合，1例患者采用与右心房吻合。
BCS的静脉重建无需使用补片成形术即可实现，在选定患者中可安全切除下腔静脉。考虑到腔静脉供体稀缺，活体肝移植是治疗BCS的可行选择。
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